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July 01, 2017

Grandparents Raising the Children of the Opioid Epidemic

Ana Beltran

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

 “For my 50th birthday, I got a two year old. My story isn’t unique. The [opioid] epidemic has devastated communities all over the country. It doesn’t discriminate against age, race, or gender. It affects all of us.”—Grandparent Pamela Livengood

Opioid Crisis Impacts Relative Caregivers

After years of decline, the overall number of children in foster care is on the rise. From state to state, experts say the current opioid and heroin epidemic is the reason. With this increase, the foster care system is relying more and more on relatives like Ms. Livengood to care for children. Since 2008, the percentage of children in foster care with relatives has gone up from 24 to 30 percent.1 Simultaneous with this increase, the number of children placed in group homes and nonrelated foster homes has gone down. Relatives are coming to the rescue and raising these children whose parents are unable to parent due to heroin and other opioid use or treatment, incarceration, or overdose death. In some parts of the country, the growing reliance on relatives is even more dramatic. In Ohio, which is one of the states hardest hit by this epidemic, the number of children in foster care placed with relatives has gone up 62 percent since 2010.2

Although the child welfare system relies heavily on relatives, there are many more children outside the foster care system in the care of relatives. In fact, for every one child in foster care with a relative, there are 20 children outside of foster care in the care of relatives.3 Compelling data is lacking on how the opioid epidemic is also causing these numbers of children to increase, but anecdotally we know they are.

Policy and Practice Tips

In light of these staggering statistics, Generations United responded by releasing its 2016 State of Grandfamilies Report focused on this crisis: Raising the Children of the Opioid Epidemic: Solutions and Supports for Grandfamilies.  The report addresses grandfamilies both in and outside the foster care system. It provides background on the epidemic, highlights personal stories and programs that help grandfamilies, and features concrete policy and program recommendations that can be implemented to help support all grandfamilies. Recommendations include:

Provide Preventative Services

Children have been unable to be raised by their parents due to other devastating drug epidemics, including crack cocaine and methamphetamine. We must learn from those experiences and be ready to act to better support the impacted children and families. Consider what happened during the crack cocaine epidemic. At the beginning of that crisis, the number of children in foster care had increased slightly. By the time the epidemic was ending, the numbers of children in the foster care system had gone up by almost 70 percent, from 276,000 children at the end of 1985 to 468,000 in 1994. During this same time, there was a 40 percent increase in the number of children living with their grandparents or other relatives.4

One of the best ways to ensure large numbers of children are not removed from their parents again is by providing preventative services. This includes ensuring parents get the treatment they want, relatives get the support they need, and children are safe and stable in their own homes. One primary recommendation in the Generations United report is to reform federal child welfare financing to encourage a continuum of preventative tailored services and supports for children, parents, and caregivers in grandfamilies—services such as kinship navigator programs, substance abuse treatment and prevention services, mental health services and in-home supports.  Well-supported families will prevent children from entering foster care. 

Ensure Health Care Access

Additional key recommendations that will help families both inside and outside the foster care system include protecting the Social Services Block Grant (SSBG) and ensuring that Medicaid is protected as the essential health care coverage it is for many grandfamilies. Legislative efforts must do no harm to the ability of the children and caregivers in grandfamilies to access quality health care or to the ability of parents to obtain substance abuse treatment. Other essential safety net programs, such as Temporary Assistance for Needy Families (TANF), Social Security, and tax credits must be protected and improved through a number of concrete policy and program steps, including preserving the ability of grandfamilies to qualify for the Earned Income Tax Credit. 

Ensure Relative Supports Are in Place

The National Family Caregiver Support Program is also an essential resource for many grandparents and other relatives age 55 and over. Although all states and Area Agencies on Aging can provide supportive services, such as respite, counseling, and support groups, to these caregivers, many do not. Generations United recommends that states use the full 10 percent of their funding to serve grandfamilies.

Address Foster Care Licensing Barriers

For relatives caring for children in the foster care system, Generations United urges states to address barriers to licensing grandparents and other relatives as foster parents. Although 30 percent of children in foster care are placed with relatives, many of those relatives are not licensed and therefore are not given the financial and other supports that go to licensed foster families. Generations United recommends that states work on addressing this inequity in part by addressing licensing barriers, many of which are caused by states’ own licensing standards. Generations United, in partnership the ABA Center on Children and the Law and the National Association for Regulatory Administration, with support from the Annie E. Casey Foundation, created Model Standards to eliminate these unnecessary barriers. Generations United encourages states to adopt those standards.

Coordinate Services at the State and National Levels

All agencies serving gandfamilies - child welfare, aging, and economic security—must coordinate services and supports at both the federal and state levels so  more children and caregivers can be served. For example, in Washington State, key staff from each of the state child welfare, aging and economic security agencies meet regularly to coordinate efforts on behalf of grandfamilies. That type of coordination helps agency leaders understand and address barriers across systems and improve access to services and supports for grandfamilies. 

Generations United is working to help the field learn from the past and implement these recommendations to better support the children, parents, and caregivers in grandfamilies. Generations United’s report has provided the background and inspiration for a Senate Aging Committee hearing in March 2017 and motivated members of Congress and others to support the children and caregivers in these families. Working together, we can ensure the opioid epidemic does not devastate more families and communities. 

Ana Beltran, JD, is a special advisor at Generations United, Washington, DC.


1. U.S. Dep’t of Health & Human Servs., Admin. for Children & Families. Preliminary Estimates for Fiscal Year 2008 and Preliminary Estimates for Fiscal Year 2015. Washiington, DC: Adoption and Foster Care Analysis Reporting System (AFCARS), no. 16 (October 2009) and no. 23 (October 2016).

2. Public Children Services Associates – Ohio (PSCAO). The Opiod Epidemic’s Impact on Children’s Services in Ohio, 2017 (PowerPoint presentation). 

3. State of Grandfamilies 2016 - Raising the Children of the Opioid Epidemic. Washington, D.C.: Generations United, 2016, available at or

4. Ibid.